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Women’s healthcare and the concept of mind-body interaction

Throughout history, and across many different cultures, the human being has been considered to consist of a mind with body (and sometimes a soul). Despite this, across much of modern medicine there has been a tendency to conceive of these aspects as distinctly separate entities, whether in disease generation or in its management. The problem of such an approach is that it engenders a sort of Cartesian confusion. In this way, healthcare providers may become oblivious to the idea, which seems so obvious to those who have not been blinded by excessive reductionism, that both of these facets can interact to manifest clinical conditions. This should not be a surprise since the findings of modern-day neuroscience have revealed an intimate link between the mind and the brain, and therefore the nervous system and the rest of the body – the scientific basis of the mind-body connection.

Whilst our understanding of the physiological systems underlying these mind-body, or “psychosomatic” interactions (from the Greek for mind and body), has improved greatly over the past century, their clinical relevance was recognised as early as the Greco-Roman era. Even before the days of Hippocrates, Soranus, and Galen, mind-body approaches were applied clinically in ancient Mesopotamia, Egypt, India, and China (irrespective of significant differences in their underlying theoretical frameworks). However, as with much of the knowledge that was scattered or lost in the days following the collapse of the Roman Empire, learned medicine, and thus mind-body thinking, seemed to have mostly disappeared from Europe by the early Middle Ages. It resurfaced in the 11th century, when Latin scholars working at the first European medical school in Salerno conferred comprehensively with experts in Greek and Arabic medicine, including discussions on women’s health topics such as infertility and childbirth.

Hippocrates demonstrating the need for doctors to continue updating their knowledge even in historic times. Hippocrates, Aphorismi, manuscript by Wellcome Images. CC BY 4.0 via Wikimedia Commons.

With the arrival of the Enlightenment, psychosomatic medicine became dichotomised in the West, so that physicians were dealing with the physical aspect of health, whilst religious leaders dealt with the soul. However, even in this era, the utility of the psychosomatic concept continued to be recognised by certain perspicacious practitioners. These included the two Williams – Osler, the renowned Canadian physician; and Smellie, the Scot considered one of the forefathers of modern obstetrics, who applied the mind-body concept to the management of conditions such as hysterical paralysis or postpartum mood swings, respectively. These practitioners understood the clinical importance of addressing both aspects in many of the patients who sought their advice.

Since then, mind-body concepts have continued developing to facilitate accurate diagnosis and guide treatment, based on the patient’s clinical features. Today’s doctors would have honed clinical observation to become skilled at effective patient management. In so doing they have followed the same guiding principle that was practised by adept Greco-Roman or ancient healers. Even though today’s doctors have additional technology to aid in evaluation and clinical diagnosis, selecting such investigations for a given patient can be difficult. This is particularly relevant to those less familiar with clinical features, such as those in early training, or those less aware of the role of psychosomatic interactions in generating certain diseases, so that only the physical aspect is addressed, often limiting the benefit of any therapeutic intervention.

Such a clinical conundrum has been noted in medical practice by doctors aware of mind-body interactions, who frequently encounter patients who have visited several healthcare facilities in search of a satisfactory answer for their recurring symptoms, despite having followed medical advice. In some women, physical, mental, and social factors alike could be inextricably bound up in the presentation of chronic conditions, such as pelvic pain. Managing such patients can be a challenge for health providers, as pain may persist even after aggressive surgery to alleviate the pain if the underlying cause remains unaddressed. This is where psychosomatic evaluation comes in – a more comprehensive approach enables such conditions to be managed effectively, particularly if consultations are provided early in the course of the disease.

A range of unaddressed psychological issues can lead to physical illness. Angst by johnhain. CC0 public domain via Pixabay.

As was documented even in ancient texts such as Soranus’ Gynaecology, it is widely recognised today that psychosocial pressures can affect ovulation, and, more generally, a couple’s fertility. Accordingly, women may be unable to conceive without maintaining environments that are conducive to conception. Psychosomatic repercussions can affect them when failures occur, particularly if adequate counselling is inaccessible. Furthermore, mood symptoms associated with physical illnesses can manifest both during and after pregnancy, even if the woman had wanted, and had successfully delivered, a healthy baby. This can be related to their experience of childbearing, as well as its effects on the normal functioning of pelvic organs. A lack of support from partners, family, or health-carers may aggravate this further, resulting in ill-effects on physical, mental, and social health. Pregnancy can also be associated with benign or pre-malignant conditions that affect outcomes. Management of these medical challenges can benefit considerably from full-field evaluations. It therefore seems pertinent to apply the concept of mind-body interaction to the clinical evaluation of presenting symptoms.

Moreover, in a resource-strapped health service, there can be a considerable wait for specialised investigations. Globally, it may be difficult to provide certain investigations such as specialised scans where there are economic constraints, inadequately trained staff to interpret relevant results, or technicians to maintain such devices. Hence, considerable reliance has to be placed on bedside evaluations. Additionally, the basic infrastructure to support assessment of presenting symptoms, particularly in relation to mind-body interactions, can be problematic in less economically developed regions of the world, especially in zones affected by warfare. Ironically, patients in such areas are at increased risk of acquiring post-traumatic stress disorder, and other health conditions which would particularly benefit from psychosomatic evaluation and biopsychosocial support. Society may have to deal with the neglect of women and families’ health needs when displaced by migration, whether for economic benefit or for safety when fleeing from warring factions. The negative impact on future societies can be long-lasting.

Many patients are affected by psychosomatic conditions which cannot be categorised as arising solely from either the physical or the mental sphere. This article merely skims the surface of these, although they affect a large proportion of patients visiting healthcare facilities worldwide.

Is the need for greater recognition of mind-body interactions staging a comeback in healthcare? It appears so.

Featured image credit: Nerves by geralt. CC0 public domain via Pixabay.

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Common pitfalls for UKCAT students and how to avoid them

The UK Clinical Aptitude Test (UKCAT) is a widely-used admissions test which allows UK universities to evaluate the current skills and future potential of prospective medical students. Thoroughly preparing for the five separate sections of the UKCAT can be a daunting task, so the examination experts at Kaplan have pinpointed six common pitfalls that students should avoid.

1) Verbal shock

If you have prepared for Verbal Reasoning and practised for the brutal timing in this section, then hopefully it won’t come as a nasty surprise on Test Day. However, even the most experienced students may find that they struggle to keep up with the required pacing. With 21 minutes to answer 44 questions, you cannot take more than 30 seconds on any individual question unless you answer another question more quickly – or unless you skip some questions. Keep an eye on the clock, to ensure that you do not spend too long on any one question or set. You may need to flag the tougher questions for review instead of attempting them properly but mark an answer for every question when you see it for the first time. Even if you are making a random guess, it’s better to mark an answer than to leave it blank. The computer cannot tell if you got the question correct by doing the proper reasoning or because you guessed randomly. If you leave it blank, you will get zero marks.

2) Calculator usage

Practise using the calculator in the official practice questions on the UKCAT website, as this will simulate the onscreen calculator you must use on Test Day. Many test centres have keyboards with a number pad at the right, which you can use to enter the figures and operation signs in your calculations. Be aware that you may need to clear the calculator after each question. Also, be careful not to use the mouse to click the calculator buttons or (in test centres with touchscreen monitors) not to touch the calculator buttons on the monitor, since either approach will be slower and more prone to errors than using the keyboard.

3) Fatigue or ‘glazing’

The UKCAT is a very intense two hours without a break. You will probably not have taken any exams previously that required you to answer more than 200 questions in such a short time. The only ‘break’ of any kind from answering questions is the minute to read directions at the start of each new section. After the first section, we recommend using that minute to close your eyes to try and refresh your eyesight. Looking at a monitor for two hours without interruption will tend to tire your eyes, so do not be surprised if you experience ‘glazing’ in the later sections. Glazing occurs when you struggle to focus on and process the words. Resting your eyes in the minute for directions is one way to combat this; another is to schedule your test appointment for the time of day when are you are least susceptible to fatigue or glazing.

4) Pacing slippage

It’s relatively easy for any student to struggle with pacing. For the well-prepared test-taker, the danger is that you might find yourself trying to be a bit too diligent or too thorough with any single question. Remember, each question is worth one mark, regardless of difficulty or the time required to find the correct answer. As soon as you notice that you are taking a bit too long on a question, call time; mark an answer (make a best guess from any remaining answers), flag for review, and move on. Try to put any such questions out of your mind, at least until you come to the review screen at the end of the section. At that point, you will need to prioritise which questions to go back to in your final moments. If there is no time to review questions, then at least you will have marked an answer.

“You often won’t realise you have been sucked into a black hole question until it is too late”

5) Black hole questions

You often won’t realise you have been sucked into a black hole question until it is too late. Any question that takes up far more time than it should is a potential “black hole”. These include any of the objectively difficult questions in each section, though there could be other black holes for other reasons. For example, if a Verbal passage deals with a topic that you find interesting, you could let yourself be drawn into reading it a bit too thoroughly, and easily waste enough time to answer one or two other questions. Abstract Reasoning tends to have a black hole effect when the patterns are hard to spot – students who are very keen can fall into the trap of thinking ‘I’m nearly there, let me just keep counting or checking the colours’, and then all of a sudden you see you have spent three minutes looking for the patterns in a single set. Keep an eye on the clock, and be aware of the danger of black holes, so you do not succumb to their pull.

6) Comfort issues

There are a few practical issues to bear in mind as you get ready for Test Day. You will be sitting the UKCAT in the summer, so it could be quite a warm day – but the temperature in the test centre may not correspond to the temperature outside. Dress for comfort – wear jeans, trackies or shorts, if you like – but you may want to bring an extra layer, such as a hoodie or cardigan, in case it is unexpectedly cool inside the test centre.

It is advisable to make a toilet break at the last minute, once you arrive at the test centre but before entering the computer lab, to limit the risk of any such necessities during the exam itself. If you have a cold or might need a tissue, be sure to get some tissues from the test administrator – the same person who gives you your noteboards and pens – as you will have to leave everything in your pockets in a locker. Finally, don’t be afraid to take a moment before beginning the test to adjust your test station. Make sure that your chair is at a comfortable height: these are usually office chairs, so you can raise/lower the seat with the lever underneath. You will only need the keyboard for Decision Making and Quantitative Reasoning, so you may wish to move it to one side for the other sections so you can have your noteboard and mouse front and centre. You can also request earplugs or headphones from the test administrator if you find the noise of the testing room distracting. If you are susceptible to noise issues, then you might want to use the same when sitting your UKCAT practice tests so you can get accustomed to the extra equipment.

Featured image credit: Fireworks by Pexels. CC0 public domain via Pixabay.

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How well do you know the foods of Ramadan? [quiz]

Ramadan is the ninth month of the lunar Muslim calendar and a period of 29 or 30 days each year in which practicing Muslims fast during daylight hours. The morning meal, suhur, must be finished before dawn, and iftar, the evening meal that breaks the fast (sawm), cannot occur until after dusk. While the commitment to prayer and hours of fasting build community, so do the extensive preparations for the breaking of the fast with friends and family at iftar each night.

The Ramadan iftar has an extensive history and important place in the Muslim world due to its communal and festive nature. How well do you know the foods, desserts, and celebrations of Ramadan?

Featured image credit: Traditional Ramadan meal, Subcommandante, CC BY-SA 3.0 via Wikimedia Commons.

Quiz image credit: Dates and apricots. By Abdulla Al Muhairl. CC BY 2.0 via Flickr.

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300 years of fraternal history

Around midsummer 1717, the first masonic Grand lodge is said to have been created in London. Although the event is not documented in any primary sources, Freemasons across the globe – and there are between 2 and 3 millions of them  – celebrate this tercentenary with a host of special events: concerts, exhibitions, and parades. But what role has the fraternity – that in our day also includes a growing number of women – played in history? Who were the men (and women) attracted by secrecy, initiation, and symbolism? Are the masonic lodges precursors of modern civil society?

Our view of freemasonry oscillates between two typical positions: idealization and distrust. Pierre Bezukhov, the hero of Tolstoy’s War and Peace (1869) joins a masonic lodge in St Petersburg which marks a profound transformation. Pierre develops an ethos of philanthropy and global consciousness and there is no doubt that Tolstoy viewed the brotherhood as a positive force in history, which of course most of masonic practitioners have done since its inception.

But at the latest, starting with the French revolution, another image has prevailed. In a nervous search for culprits, the spotlight was directed towards fraternal orders such as the Freemasons or the infamous Bavarian Illuminati that could be blamed for the downfall of crown and church. Since then freemasonry has been the object of conspiracy theories preferably in authoritarian states. But even in Britain an Unlawful Societies Act was adopted in 1799 that placed masonic lodges under governmental control until 1967. And about three decades later, the Home Affairs Committee investigated the alleged influence of freemasonry in society, triggered by some high profile miscarriages of justice.

Modern freemasonry became a global movement in the 18th century and its ideas have since created a considerable social, cultural, and political impact. Since its official inception in 1717, without any formal governing body, it spread throughout the world as a prominent feature of associational life. It became one of the largest non-governmental secular organizations. Following a dispute over ideological matters in the 1870s, the masonic world is divided into two main spheres of influence: lodges adhering to the United Grand Lodge of England (UGLE, 1717/1813) and those adhering to the Grand Orient de France (GODF, 1738/72). Besides these two major masonic bodies there exists a large number of independent, self-authorized masonic lodges and masonic-like fraternal orders. Female membership is today a prevalent yet still disputed feature of freemasonry. And a wide range of other fraternal organizations were established, based on principles of freemasonry.

The historical origins of freemasonry are to be found in medieval professional craft-guilds for stonemasons, active in the construction of cathedrals, churches, and secular buildings around Europe. Modern freemasonry was modelled on the imaginative world of these guilds, with their architecture and geometry, mythology, symbols, feasts, and rituals, and it represents both in real and in imagined terms a continuation of this heritage. Strikingly, blended into this heterogeneous mix was the powerful idea of descent from Chivalric orders in general and the Knights Templar in particular, as well as from Greek and Roman mystery cults.

The medieval heritage was later merged with the scientific and associational culture of the early Enlightenment, creating an eclectic mixture of intellectual and religious traditions. It was now, that freemasonry for the first time opened up to female membership and developed features of a strong associational impulse constituting a school for self-governance and democratic government.

Against the backdrop of a strongly polarized view on freemasonry, recent scholarship has attempted to clear a middle ground from which fraternal history can be studied, solidly based on documentary evidence.

The idea of a universal, all-embracing brotherhood has clear elements of cosmopolitan thought that recur throughout the history of freemasonry. However, prominent freemasons have been involved in a number of national liberalization and independence movements across the globe. And despite its cosmopolitan ethos, issues of race, religion, gender, and sexual orientation illustrate the fault-lines and limits of masonic tolerance.

Since the early 18th century there has also been a friction between established Christian churches and freemasonry. Starting with 
the first papal ban in 1738 (followed by many more), the Catholic Church was most prominent in its condemnation of freemasonry. These condemnations have however not prevented practicing Catholics from joining masonic lodges, and in countries like Ireland freemasonry was and is particularly evident. At least since the French Revolution, freemasonry has been accused of orchestrating radical political change. Reinforced by anti-masonic and anti-Semitic writings at the turn of the 19th and into the 20th century, European right-wing groups mainly after World War I absorbed this anti-masonic ethos into their ideological and political agendas.

After a negative trend in membership recruitment following the 1960s, there have been signs of recuperation not least occasioned by the collapse of Soviet communism after 1990, and many new national grand lodges have been established in central and eastern Europe.

Against the backdrop of a strongly polarized view on freemasonry, recent scholarship has attempted to clear a middle ground from which fraternal history can be studied, solidly based on documentary evidence. Spearheaded by individual researchers in France, Austria, and the US and occasioned by a new availability of sources since 1990, a growing global group of scholars has produced primary research that throws new light on the fascinating history of the brotherhood. This trend has manifests itself in the publication of handbooks, critical source editions, academic journals, and conferences devoted to the subject.

Featured image credit: The traditions, origin and early history of Freemasonry (1882) by Internet Archive Book Images. Public domain via Wikimedia Commons.

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Why should I trust you? AMBIT: helps where it’s hard to help

Teachers to nurses, youth workers to psychiatrists, psychotherapists to social workers—you name it, we are legion; the “helping professions”. We’ve made progress over the past century, finding effective ways to help many – perhaps most – of the difficulties our clients face, but we shouldn’t be complacent. Even the most “evidence-based” of our interventions are only effective for 50-60% of the cases that they are used with. When we do offer help, the more concurrent problems a client has, the more likely it is that they won’t improve. So despite being referred to as the helping professions, we don’t always help; accepting this is not as easy as it sounds.

Who wouldn’t want to badge their work as “helpful”? No one (well, not that I’ve met) comes to work with the intent of being unhelpful, yet if we are honest, the experience of being told robustly “This isn’t helpful!” is something most of us who try to help are familiar with. Ironically, though perhaps unsurprisingly, it is often the clients that we most worry about who react in this way.

What about these people, those not helped by the standard approaches that help so many others so well? They get labelled as “complex”, with “multiple comorbidities”, “treatment resistant” or “hard to reach”; everything we know suggests that their “problem” is not captured by the nature or degree of a specific diagnosis. Alongside the professional tasks of delivering, coordinating, or integrating help, at least as important is the fact that, for many clients, the ordinary channels for accepting help are blocked.

‘The first “key” to epistemic trust consists of “ostensive cues”, wake-up signs that alert us to the fact that the person in front is about to say something of specific significance to me.’

“Epistemic Trust”, and research into this, is a helpful window onto this conundrum. Want to open a door that is locked fast? You’ll need a key. Through some elegant experiments, researchers have looked for and begun convincingly to identify a range of keys that allow clients to “open up” to help.

The first “key” to epistemic trust consists of “ostensive cues”, wake-up signs that alert us to the fact that the person in front is about to say something of specific significance to me. This includes things like eye contact, the to-and-fro of well-timed reciprocal turn-taking in conversation, and gently exaggerated tones of voice (mothers speak to their babies in that sing-song tone known as “motherese”).

Second, having got my attention, the most powerful key of all is the offer of contingency—a fit between my experience (what it’s like to be me, here, right now) and what I see reflected back in this helper’s face, their voice, the content of what they say, their physical responses. When a potential helper gets this right about me, I feel recognised (think about that word: re-cognised) as though the other person has ‘got’ me; my specific here-and-now predicament is reflected back, compassionately. I feel understood in such moments, and thus perhaps understandable, or validated. This is a good feeling, of course, but it is also the key, par excellence, for unlocking the door to help, for opening the “epistemic superhighway”.

Experiencing this sense of being-understood, epistemic trust grows in me towards the person showing that understanding. Epistemic trust is a specific form of trust, not just in that person generally, but in the social value of what they seem to understand about the ways of the world.

With epistemic trust, I’m prepared to take in advice/information/help on offer, and even more importantly, try it out elsewhere in the social world. In the mind of the person helped, the belief arises that “if this person is that good at ‘getting’ me, then what they say must have value beyond just their mind.” Believing that, I’m more likely to try out new ways of being, behaving, or responding in other areas of my life, with other people. Assuming that what I learn is actually helpful, and critically that my social world is benign enough, then I just may get positive feedback from these new attempts at solving old problems. And that is learning.

Now that “skill” of making sense of my behaviour is what we refer to as mentalizing. Applying this framework for understanding human communication in therapy has already proven helpful and effective with a wide range of difficulties, starting with the Borderline Personality Disorder, using the therapeutic approach known as mentalization-based treatment (MBT).

Image by Bevington, Fuggle, Cracknell and Fonagy. Used with permission.

AMBIT (adaptive mentalization-based integrative treatment), developed for the most complex, risky, and commonly non-help-seeking populations, has grown out of the MBT family of treatments that have developed mentalizing approaches for individuals, families, groups, children, and adults. AMBIT uses the same theoretical framework of mentalizing, but does so with a whole-systems emphasis, considering the wider context in which systems of care are situated.

A typical client of an AMBIT-influenced team might be a 19-year-old with a long history of neglect and undisclosed trauma in his early life, who has been known to child services because of questions about ADHD and conduct problems, whose offending behaviour and homelessness now brings him to the attention of services. He rejects the local authority’s offer of a hostel bed, because it insists on no alcohol and attends the hospital later that day, having taken an overdose, revealing multiple scars to his forearms.

AMBIT does not only encourage workers to use mentalizing techniques with their clients, but insists that they balance their application in three additional directions. The purpose is to support workers to maintain their balance sustainably – in a field of work that often leaves them feeling out of balance. If you think you always know exactly what is going on and what to do in this line of work, then you are probably dangerously out of touch with the complex, murky, risky reality of your role as a helper.

In addition to working with your client, the extra three areas where mentalizing can enrich and stabilise practice are working with your team, with your wider networks, and learning at work.

AMBIT is an approach that has itself developed as a ‘learning organisation’, building and broadcasting its learning as it goes in a flexible online ‘wiki’, rather than limiting itself to static print publications. AMBIT is co-produced by academics, clinicians, and more than 2000 trained field workers who have been able iteratively to feed back their own experiences—refining, pruning, and enriching the model, which continues to adapt and grow: street level experience is balanced with research evidence. AMBIT has described itself as an ‘open source’ approach to the development of effective practice for clients whose complex, multiple, difficulties (and low epistemic trust) renders them less able to benefit from conventional, often rigid, albeit evidence-based forms of treatment.

Featured image credit: Helping hands by InsidePhotography. CC0 Public Domain via Pixabay.

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Excuse me, but who’s telling this story?

Ian McEwan’s latest novel, Nutshell, published in paperback this June, the month in which its author turns 69. McEwan forged an edgy early reputation by shell-shocking readers, or at least reviewers, with the violent, sexualised or neglected child narrators of his short stories. To find a narrator to recount the story Nutshell, he regresses back to the womb, literally. The novel’s story is told by an unborn foetus, comfortably sequestered away from the world and alone with his own thoughts. The narrator is however worried about the plot being hatched by his mother Trudy and his father’s brother Claude, placing him in a position the book’s title likens to Hamlet’s remark that “I could be bounded in a nutshell, and count myself a king of infinite space, were it not that I have bad dreams.”

McEwan’s approach in Nutshell is highly unusual and brings to mind several other extraordinary narrators. There are the surprising child narrators of a number of excellent recent novels, ranging in age from the fifteen year-old Christopher with Asperger syndrome in The Curious Incident of the Dog in the Night-Time by Mark Haddon to the imprisoned five-year-old Jack of Emma Donoghue’s Room. There are other storytellers nearly as young as McEwan’s foetus, such as Muriel Spark’s narrator in the self-explanatory short-story “The First year of my life.” Still more extraordinary are the non-human narrators, such as, for example, the few that are best described as ‘bug-like’, from Kafka’s insect Gregor Samsa in “Metamorphosis,” an inspiration for McEwan’s novel for children The Daydreamer, to the woodworm who narrates the opening story of A History of the World in 10 1/2 Chapters, a novel by McEwan’s friend Julian Barnes. There are additionally those that are not human, but who are also not animal, such as the antique bowl who narrates Tibor Fischer’s The Collector Collector or the self-aware supermarket trolley that narrates Bo Fowler’s Scepticism Inc.

In recent years, McEwan has enjoyed playing with questions of authorship and narration in order to foreground this aspect to fiction but also to highlight its use of imagination and even deception. His recent short story for The New Yorker, “My Purple Scented Novel”, includes a reference to McEwan as the novelist “with the Scottish name and the English attitude.” The story has a literary theft at its heart, as one author photocopies a draft of a fellow writer’s novel and, by publishing first, frames his long-standing friend and far more successful literary rival as a plagiarist. McEwan himself is unhappily accustomed to occasional accusations of passing off the words of others as his own, particularly with respect to his best-known novel, Atonement. It is arguably ironic therefore that Atonement itself purports to be a conventionally narrated third-person novel until its ending implies it to be the work of one of its characters, an author remembering her own catastrophic childhood mistake of making up a story about other people. A more recent literary spy-novel by McEwan, Sweet Tooth, has one chatty, confidential first-person narrator until its closing pages make it appear to have been chiefly the work of another character, an author whose first fictions have a striking resemblance to those early short stories of McEwan’s. One of which, by the way, is narrated by an ape.

The question of who is telling a story tends to be one we forget as we immerse ourselves in an enjoyable novel, unless the writer forces us to take notice, at which point our enjoyment may diminish. Yet, the characters who influence us most are frequently those narrators, often unreliable, who bring a unique tone and perspective to the telling of the story. These are the best ventriloquist’s voices without whom, to take one example, the Great American novel would not exist, or at least not with The Adventures of Huckleberry Finn, Moby Dick, The Great Gatsby, The Catcher in the Rye, Invisible Man or To Kill a Mockingbird. It is the story that matters most for many readers, but for an author, especially one such as McEwan, it is equally important who is narrating it; so perhaps it should matter to us too, even if we wish to trust the tale and not the teller, whoever that may be.

Featured image credit: Ian McEwan at the London Book Fair 2017. ActuaLitté, CC BY-SA-2.0 via Flickr.

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The Nixon tapes and Donald Trump

Since President Trump’s inauguration, and even before, there have been countless comparisons between the 37th and 45th presidents of the United States. Some of the comparisons make sense, while others do not.

For this reason, when I was called upon to ask a question at the 16 May, 2017 CNN town hall debate between Governor John Kasich and Senator Bernie Sanders, and I chose to ask a question about Richard Nixon and Donald Trump. For more than a decade now, I have been transcribing the secret White House tapes of President Richard Nixon. To date, I have transcribed more than anyone else, and have made the audio available as a free public service online.

(My question was never really answered.)

Perhaps the most important similarity between Nixon and Trump is that each trusts no one more than he trusts himself. That led Nixon to record more than three thousand hours of his conversations and telephone calls secretly, so that he alone had the complete record of what was said in his presence. I suspect that if Nixon’s tapes had not played a starring role in his downfall, he would have retired to California as planned and wrote his Churchillian multi-volume memoirs. Or, if he had not taped at all, odds are he would have completed his second term. It was not until the revelation that he had taped that we could satisfy Senator Howard Baker Jr.’s admonition to discover “what did the president know and when did he know it.” Taping was the key; the tapes showed what Nixon knew and when he knew it.

In the case of Trump, discussion is now swirling over whether he taped, and whether he is still taping. I, for one, hope he is. In fact, the historian in me wishes that all presidents did. Not voluntarily, but according to statute. Wouldn’t it be great if we could one day know the truth? Even if the tapes were sealed for 50 years, or until everyone that was recorded is dead? And, if the president acted up, taped conversations could be the ultimate act of accountability to the people.

As long as Trump avoids his ‘Watergate’, his tapes will remain secret. Of course, that is if he is disciplined enough not to share them when it suits his interests. That could be a big if. The Trump Tapes would then be processed some decades from now for eventual public release by the National Archives and Records Administration according to the Presidential Records Act.

On the other hand, if Trump has tapes, or is taping, doing so would be a high stakes gamble. As Nixon said to David Frost in 1977, “I gave them a sword, and they stuck it in and twisted it with relish.” Nixon’s tapes were the sword, a sword that could be used against Trump, too, if he is not careful. Nixon and Trump could end up having even more in common.

 For a president, the appeal of taping is multifaceted. It is the chance to nudge history, to shape it.

When Nixon’s White House staff discovered they had been secretly taped, their reactions varied. Some believed the president was entitled to a verbatim record of their communications, even if it meant being secretly recorded. Others felt betrayed. Still, others went on to have political careers, never fully independent from their old boss. With each new opening of Nixon tapes – approximately 700 hours have yet to be released – the same old fears return. “What did I say? What did he say about me?”

For a president, the appeal of taping is multifaceted. It is the chance to nudge history, to shape it. A president dares not leave his historical legacy in the hands of those who opposed him, or even to benign neglect. Also, as a general rule, a president cannot expect to be treated fairly during his lifetime. Tapes can be very helpful to overcome this – a way of leaving your unfiltered thoughts to future generations.

Every president desires to create some degree of mythology about himself, his words, and his actions. Presidents do this a number of ways. They invite selected historians in, on their terms, to record what they see and hear. Although the group and moment must be chosen, a president must not be afraid of the fact that they might not all be friendly to him. The president will still control the rules of engagement, and can invite them to see and hear things that serve the president’s purpose.

Presidents have also established a council of historians, whether formally or informally. President Obama did this, and recent historians have called for the role and membership of this group to be more formalized. Meetings can be formal or informal, and as frequent or infrequent as the president desires. Going beyond the group, a president sometimes takes a historian into their confidence, and uses them to nudge history. Leaders have been doing this since at least the time of Alexander the Great.

If there is one thing President Trump seems to appreciate, it is that it is better to be hated than forgotten. But he needs some mythology. The Kennedy White House did this with the creation of Camelot. Richard Nixon, despite the fact that many of his advisors recommended that he burn his tapes, remains an active topic of debate – arguably more so than any other modern president. Even President Reagan’s premature departure from public life due to Alzheimer’s during his final decade of life helped to create the mythology of Reagan with us today.

I do not think Trump will ever be universally loved, but that does not bother him as much as we think. A president can still be consequential, significant, momentous, and history-making without being liked. But Trump will need a little mythology. Taping could help.

Just don’t get caught.

Featured image credit: President Nixon, with edited transcripts of Nixon White House Tape conversations during broadcast of his address to the Nation by National Archives & Records Administration. Public domain via Wikimedia Commons.

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The composer who broke the rules

Imagine if Charles Dickens had left a record of some of his technical decisions—why, for example, he so often used a verbless sentence; or if Joseph Mallord William Turner had explained to his contemporaries why he chose a certain vivid pigment which he knew would fade over time. We’d regard such information as giving valuable insights into the creative mind. But explicit communication between creative artists and their public is rare before the late nineteenth century, so we are indeed lucky to have a transcription of a series of conversations between Olivier de Corancez, editor of the Journal de Paris, and the opera composer Christoph Willibald Gluck, in which Gluck explains with striking clarity his artistic creed, his approach to dramatic expression, and why he broke so many rules.

Olivier de Corancez was responsible for introducing Christoph Willibald Gluck to Jean-Jacques Rousseau, and his account begins by reproducing Rousseau’s admiration for Gluck, whom Gluck came to regard as the perfect listener. This encouraged Corancez to raise a number of problem passages with the composer. What is surprising about the interviews is the degree of detail interrogated. Corancez queried single notes—the difference between a crotchet and a quaver—which might easily escape the notice of a casual listener, and he was remarkably daring, challenging what he saw as lack of melody, an excess of repetition, and ill-judged expression. Gluck’s replies are invariably bold and confident, and he justified his choices by appealing to psychological truth, which he calls Nature. Corancez picked out, for example, a phrase from an aria in Iphigénie en Aulide, where Gluck had set the line “Je n’obéira point à cet ordre inhumain” (I will not obey this inhuman command) in two ways, initially with a long note on the first word, and subsequently with a short note. Corancez confessed that for him, “the long note spoilt the melody”. Gluck’s reply is prompt and plausible:

I had a strong reason not only for putting a long note on the ‘je’ the first time Agamemnon sings it, but for suppressing it at every repetition. The prince is torn between strong opposing forces, Nature and religion. Nature wins in the end, but he needs must hesitate before disobeying the gods, and the long note represents his hesitation. But once he has made his decision, there is no more hesitation, and the long note would be unnecessary.

Several of Corancez’s questions involve what might seem to be a fault in Gluck’s word setting. From the same opera, he drew attention to the chorus of Greek soldiers who interrupt attempts to spare Iphigenia’s life with a short, brutal demand for her sacrifice, repeated note for note throughout the third act. Olivier de Corancez criticised both the lack of melody and the unvarying repetition. Gluck was ready with his answer:

Suppose there was famine in a country. The citizens gathered before the ruler and to his query “What do you want?” they replied “Bread”. And however much he tried to explain, they would only cry “Bread”, on the same note and with the same expression. … Here the soldiers ask for a victim. They can only utter the same words and with the same accent. … I could have composed a more beautiful chorus and made it more attractive by varying it. But then I would have been a mere musician and ignored Nature.

Christoph Willibald Gluck’s most famous explication refers to a moment in his penultimate opera Iphigénie en Tauride, where Orestes, after a frenzied outburst, throws himself onto a bench, saying that he is now at peace (“Le calme rentre dans mon coeur!”). His tranquil melody is, however, accompanied by an agitated figure played by the violas that seems to contradict the words. From the first performance of the opera, the passage attracted much criticism, and had to be explained in the press in an anonymous review, almost certainly the work of the librettist, Nicolas Guillard. Corancez picked up on the offending passage, presumably to get Gluck’s own defence of it. He queried the restless accompaniment, saying, “Surely Orestes is now at peace: he says so.” “He lies!” exclaimed Gluck, “He can never escape his madness. He has killed his mother!”

Although Gluck believed passionately and seriously in his dramatic settings, he was not without a sense of humour. When Corancez chided him over the monotone chorus of underworld gods in Alceste, Gluck responded with assumed naiveté that it was impossible accurately to represent the speech of supernatural beings “because no one has ever heard them.” Shortly before his death, however, his pupil Antonio Salieri brought him his cantata The Last Judgement, with two different settings of the voice of God, and asked Gluck’s opinion on the alternatives. “Wait a just few days,” Gluck responded, “and I’ll be able to tell you which one is right!”

How authentic is Corancez’s account of the interviews? Could he have made them up? This is unlikely. Other writers have confirmed that Gluck, particularly in his Paris years, made a highly articulate defense of his operas. He was aware that he was disconcerting his listeners, treading new ground, and breaking conventional rules of composition, but whenever challenged, he was always ready with an answer, appealing to the effect his operas produced in the theatre. “My operas,” he declared, “are not written for a single moment in time…but will please as much two hundred years hence, for they are grounded in Nature.”

Featured image credit: Portrait of Christoph Willibald Gluck by Joseph Duplessis, 1775, Kunsthistorisches Museum, Public Domain via Wikimedia Commons.

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10 of the best literary summers

The changing seasons have inspired writers, artists, and poets for time immemorial – whether it is autumnal nostalgia among the crushed leaves, the biting cold and grey skies of winter, the joys and fresh hopes of spring, or the all-enveloping heat of the summer sun. Conjuring up reminiscences of youth, long days, lost loves and memories carried on the breeze – no season has taken hold of the imagination quite like summer. Beautifully crafted descriptions of freshly cut grass, lazy days on the beach, fresh flowers, and stifling heat have frequently set the scene in some of the greatest novels and verse, and even make a recurring appearance in authors’ personal letters.

With the summer months having firmly arrived, we thought it was a good time to look at some of the most memorable and most beautiful literary depictions of summer. From Tennyson’s ‘perpetual summer’ to Charlotte Bronte’s balmy summer evenings, and from Charles Dickens’ Oliver Twist to the oppressive heat of Shakespeare’s ‘fair Verona’, discover literary summers through the ages…

Featured Image Credit: ‘A Summer Afternoon’ (1910s) by Edward Henry Potthast, uploaded by Trzesacz, Public Domain via Wikimedia Commons .

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From the life of words, Part 3: the names of some skin diseases

Leprosy

The scourge of the Middle Ages was leprosy. No other disease filled people with equal dread. The words designating this disease vary. Greek léprā is a substantivized feminine adjective (that is, an adjective turned into a noun—a common process: compare Engl. the blind and blinds, with two ways of substantivization). It meant “scaly.” From Greek the word migrated to Latin, from Latin to Old French, and finally reached English. Like so many other names of diseases, leprosy highlights one symptom of the affliction (here, “scaly skin”). As we will see, Old English had a native name; leper surfaced in texts only in the fourteenth century, and leprosy in the sixteenth. Some other languages also did without borrowing. Thus, Russian prokaza (stress on the second syllable) means approximately “disfigurement,” while in Germany the social aspect of leprosy was emphasized: Miselsucht (misel– “miserable, from Latin,” and –sucht “disease”) and (the present day name) Aussatz “outcast,” both with unmistakable medieval connotations.

Leper with bell – Pontifical (c.1400)

But in the past, some Germanic speakers had a different word for leprosy. Since lepers appear in the New Testament, both the noun (leprosy) and the adjective (leprous) occur in the fourth-century translation of the Bible into Gothic. The noun was þrutsfill, that is, thruts-fill, a compound in which –fill meant “skin,” recognizable from its English cognate fell “skin, hide” (related to Latin pellis). Old English had þrust-fell; –fell, as just pointed out, has come down to our times unchanged. The forms in both languages are nearly identical, but Gothic has ts in the middle, while Old English has st. Consonants regularly play leapfrog, and there is a special term for it, namely metathesis. The question arises which form is original and which the product of alteration. The researchers who have studied the origin of those words traditionally gave preference to Gothic. As we will see, they were probably mistaken.

The most common explanation of the Gothic and Old English words depends on the existence of the Icelandic past participle þrútinn “swollen.” Its Germanic root can be seen in Engl. throat and throttle. If this etymology were correct, the Gothic-Old English name of leprosy would mean “swollen skin.” Swelling is not a prominent feature of leprosy, and I think the etymology is wrong, but it makes me think of the Old Icelandic manuscript called Morkinskinna, literally, “moldy, rotten skin.” Could this strange name, standing in opposition to Fagrskinna “beautiful skin,” the name of another manuscript, commemorate an epidemic of leprosy or have anything to do with the disease?

The Icelandic manuscript “Morkinskinna,” which means “moldy, rotten skin.”

Long ago, in the otherwise useless commentary on the language of the Gothic Bible, the author suggested that þrutsfill is related to English thrush, not the bird name, but the name of the disease affecting babies’ mouths. This suggestion was buried in a moderately thick volume, and no one seems to have noticed it. But I am almost sure that the forgotten author hit the nail on the head.  Although some English dictionaries repeat the old opinion that the origin of thrush is unknown, the unanimous conclusion of the leading Scandinavian scholars on this question is probably correct. The word seems to have come to English from some Scandinavian language. It surfaced in English only in the seventeenth century; yet a few Scandinavian words did turn up in written English so late. The Danish and Norwegian for thrush is trøske. The same word means “rotten wood,” and this is how leprosy in Gothic and Old English must have received its name: the reference was to rot, rather than swelling. Assuming that this idea is right, the Old English word, with its consonant group st in the middle, retained the initial form, while the Gothic form, with ts, underwent metathesis. The root of the Icelandic participle and its Old English cognate had a long vowel (ū), but, if the name of the disease has nothing to do with swelling, the vowel in the old Germanic words was short.

In Danish and Norwegian, the symptoms of thrush are sometimes associated with the name of the frog (frosk). The Gothic for frog is unknown, but Old Engl. frogga “frog” has been attested. If thrush and Old Engl. þrustfell are related and their etymon means “rotten,” frogs are, as they used to say in medieval Iceland, out of the saga. The Old Irish names of leprosy, trosc, is close to the Gothic and the Old English ones and especially to thrush ~ trøske, but Polish trąd “leprosy,” occasionally cited in this connection, has hardly anything to do with it (the letter with a hook under it designates a nasal vowel, so that the root must have been trand or at best trund, but þrush– never had n in it). The bird names thrush ~ throstle are not related to any of the words discussed above. They have wide connections in and outside Germanic, and their basis is probably onomatopoeic.

Read gum

Read gum is also known as gum rash and tooth rash, probably because it tends to occur at the time of dentition. But, unlike thrush, this eruption affects the skin, rather that the gums or the palate of infants. The Neo-Greek name of red gum, scrophulus, literally “a girdling disease,” from a verb meaning “to turn, twist, twine,” quite appropriately, contains no reference to the mouth either. It seems that red gum is a folk etymological alteration of redgound, perhaps itself an alterations of Middle Engl. radegound “? a running sore,” recorded once, in 1377. Redgown(d) has been known from texts since 1440, and red gum since 1597.

Whether rade in radegound is some form of red is unclear, but –gound certainly means “puss, poison,” a word almost extinct in English dialects, though its doublet with a historically long vowel (gound) has survived. In Old Germanic, gund was widespread. For example, Gothic gund glossed Greek gággraina “gangrene” (read Greek gg as ng). The plant name groundsel is still another casualty of folk etymology, for its original form was gunde-swylige, from gundæ-swelg(i)æ, “presumably from gund ‘pus’…+ swulg-, swelg– ‘swallow’, the etymological meaning being ‘pus-absorber’, with reference to its use in poultices to reduce abscesses; on this view, the later Old English form in grund– is due to association with ground, as if taken to mean ‘ground-swallower’, with reference to the rapid growth of the weed” (so The Oxford Dictionary of English Etymology, with the abbreviations expanded).

Groundsel, the plant whose name fell victim to folk etymology.

The great Danish philologist Otto Jespersen once said that a linguist is never bored even at the dullest meetings, for, however uninteresting the presentations might be, one could always follow the speakers’ accents and take notes. The same is true of etymologists. The words may refer to distasteful realities, but a study of their origin cannot bore or disappoint.

Otto Jespersen, a taciturn man, was never bored.

Image credits: (1) “Leper with bell” Originally published/produced in circa 1400., Public Domain via Wikimedia Commons. (2 and featured image) Codex Frisianus, Public Domain via Wikimedia Commons. (3) “Common Groundsel-first fruits” by CarolSpears, CC BY-SA 3.0 via Wikimedia Commons. (4) “Otto Jespersen” by Unknown, Public Domain via Wikimedia Commons.

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